title: Recurrent Twiddler's syndrome in a nonthoracotomy ICD system despite a Dacron pouch.
abstract: Twiddler's syndrome is a highly recognized yet rare complication of pacemaker and cardioverter defibrillator (i.c.d.) implantation. We present a case in which persistent generator rotation resulted in lead dislodgment and inappropriate shocks in an initial ICD and recurrent lead fracture in a second ICD system. This case is unusual in that even with extensive surgical precautions including use of a Dacron pouch, generator rotation could not be prevented. Submuscular implantation and use of a smaller generator may prevent Twiddler's syndrome.
authors.affiliation: Regional Cardiac Arrhythmia Center, Scripps Memorial Hospital, La Jolla, CA 92037, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Higgins
authors.forename: B D
authors.initials: BD
authors.lastname: Suh
authors.forename: J B
authors.initials: JB
authors.lastname: Stein
authors.forename: D B
authors.initials: DB
authors.lastname: Meyer
authors.forename: J
authors.initials: J
authors.lastname: Jons
authors.forename: D
authors.initials: D
authors.lastname: Willis
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000523:psychology; D004868:Equipment Failure; D005260:Female; D006801:Humans; D009765:Obesity / Q000150:complications; D011093:Polyethylene Terephthalates / Q000627:therapeutic use; D012008:Recurrence; D013577:Syndrome; D017180:Tachycardia, Ventricular / Q000628:therapy
chemical_list: D011093:Polyethylene Terephthalates